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Acute Complications of Cirrhosis Masterclass by Sarah Kessler, PharmD, BCPS, BCGP

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Diagnostics & Screening

  • Appropriate screenings for unhealthy alcohol use, binge drinking, and alcohol use disorder
    • Alcohol Use Disorders Inventory Test (AUDIT)
    • AUDIT-C (questions 1-3 of AUDIT)
  • Biomarkers of alcohol use can be found in urine, hair, or blood
    • NOT recommended to use as tools to “catch” people à open the floor for discussion
    • Patients should always consent to testing

Laboratory Values

Liver Related Enzymes

Laboratory TestDescription Key Points



-Produced in hepatocytes


-Indicates hepatocellular injury

-Rapidly changing

-Inadequate to establish alcohol use


-AST:ALT ratio > 1 may indicate cirrhosis 2/2 alcohol

Gamma-glutamyl transferase



-Enzyme found in cell membranes in spleen and liver tissues


-Frequently elevated in heavy drinking


-Greater sensitivity than AST for cirrhosis

-Not specific for alcohol use

Bilirubin-Created through degradation of several heme-containing proteins


-Non-specific to liver disease

-Elevations occur in 1later disease, and may indicate more severe cirrhosis


Additional Labs

Laboratory TestDescription Key Points
Albumin-Produced by the liver in hepatocytes, accounts for 10% of liver protein production daily


-Provides oncotic pressure in plasma

-Indicator of nutritional status

-Lower albumin carries an overall negative prognosis (cirrhosis + other disease states)


-Should not be supplemented externally (ALBIOS, ATTIRE) for sake of repletion

INR-Prothrombin time compared to a laboratory normative prothrombin time


-Designed with vitamin-k antagonists in mind

-NOT an indication of bleed risk


-Patients may be in a hypercoagulable state despite elevated INR

Platelets-Synthesized by the liver


-Improved prognostic factor for bleeding when compared to INR

-Can be used as a biomarker for cirrhosis severity, not validated, taking trend and baseline into account